Tag: Whistleblower case

The Department of Justice (DOJ) intends to prove AseraCare is liable under the False Claims Act “because it caused non-terminally ill patients to prematurely give up curative or rehabilitative care so that the company could bill Medicare for hospice payments” according to DOJ attorneys.

A court document from the DOJ attorneys stated “In short, the United States’ told U.S. District Court Judge Karon Bowdre in one court document. “To the contrary, the United States brought this case based on evidence that AseraCare marginalized doctors, systematically pressured its own clinical staff to admit and keep ineligible patients, submitted false hospice claims for patients who were not terminally ill, and was put on notice from internal and external audits and employee complaints that this was occurring.”

Trial Date Set for August 3

A federal judge in Birmingham set a trial date of August 3 for this lawsuit which began when half a dozen AseraCare employees in Georgia, Alabama and Wisconsin filed whistleblower cases.

According to Patrick Burns, co-director of the Washington nonprofit Taxpayers Against Fraud Educational Fund, “It will be, far and away, the biggest hospice (FCA) case.”

Why $202 Million?

The DOJ analyzed random samples of 2,181 AseraCare patients for whom the company billed Medicare for at least 365 consecutive days of hospice care. Patients were with AseraCare for two periods: Jan. 1, 2007 and Dec. 31, 2008 and between Jan. 1, 2009 and Feb. 28, 2011.

The findings: The DOJ argued more than half of the 233 cases should have been deemed ineligible for hospice care.

“Having a few patients who live longer than six months is expected”, Burns said. “That should be one in a hundred, not fifty percent,” he said.

DOJ claims Medicare suffered nearly $67.5 million in damages due to the False Claims Act violations. According to the DOJ’s motion, if the jury awards the $67.5 million, then the judge is obligated under the law to treble the actual damages and award the U.S. a total of $202,481,144.

Congress created the Medicare hospice benefit in 1982. According to court documents, Roughly 90 percent of hospice patients are now covered by Medicare and/or Medicaid.

We will keep you posted on the events of this case. The law firm for the whistleblowers in this case is Frohsin & Barger LLC.